Managing Deterioration and Martha’s Rule
Overview
Preventing harm from patient deterioration is a key priority within the NHS Patient Safety Collaboratives (PSCs). The Managing Deterioration National Patient Safety Improvement Programme aims to reduce deterioration-associated harm through better system co-ordination and as part of safe and reliable pathways of care.
In May 2024, NHS England announced the rollout of Martha’s Rule to support earlier recognition and response to deterioration. Patient Safety Collaboratives, hosted within the 15 health innovation networks across England, have been selected as delivery partners for this work.
Martha’s Rule is named in memory of Martha Mills, who died in 2021 after developing sepsis in hospital. Concerns raised by her family about her deteriorating condition were not acted upon. A coroner later concluded that earlier escalation of care could have saved her life.
The programme introduces three core components:
- Patients are asked, at least daily, how they are feeling and whether their condition is improving or worsening
- Staff can request a review from a different clinical team if they are concerned about a patient
- Patients, families and carers can also trigger this escalation directly
During the first year of the pilot (2024/25), we supported 13 sites across 7 NHS trusts in south London. This work is continuing in its second year, with all acute hospital sites in south London now participating in the programme.
Implementing Martha’s Rule in south London
The challenge
Communication breakdowns between patients, families and clinical teams can lead to delays in recognising deterioration. In some cases, concerns are not escalated in time, increasing the risk of avoidable harm.
Solution
We are supporting the implementation of Martha’s Rule across all eight acute trusts in south London. This includes convening clinicians, patient safety leads, innovators and NHS England colleagues to share learning, develop practical tools, and support consistent implementation.
We have also supported the use of digital innovation, including our multimedia Innovator Spotlight video, which has been shared nationally and highlights solutions to improve early recognition of deterioration.
The Health Innovation Network South London’s guidance, collaboration, and responsiveness to queries have been instrumental in turning a shared vision into meaningful patient safety improvements. From strategic advice to hands-on support, their expertise and encouragement gave us the structure we needed to embed Martha’s Rule effectively and thoughtfully.
Deputy Medical Director, south London NHS Trust
1 million
Around 1 million people admitted to hospital in south London each year now have access to a rapid clinical review through the Martha’s Rule “Call for Concern” route
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